• 作者：E.S. Starling^a ; ^b ; L.O. Reis^a ; ^c ; ^{reisleonardo@zipmail.com.br} ; R. Vaz Juliano^a ; F. Korkes^a ; M. Wanderlei Dos Santos Jr^d ; A.C. Lima Pompeo^a ; M. Tobias-Machado^a ; ^b ; ^e
• 关键词：Curva de aprendizaje ; Prostatectomí ; a radical endosc&oacute ; pica extraperitoneal ; Complicaciones ; Resultados ; Morbilidad ; Resultados oncol&oacute ; gicos ; Intensivo ; Supervisado
• 刊名：Actas Urol贸gicas Espa帽olas
• 出版年：2010
• 期刊代码：pca37_02104806
• 类别：med
• 出版时间：July-August 2010
• 卷：34
• 期：7
• 页码：598-602
• 文件大小：174 K

Objective

Prospectively investigate endoscopic extra peritoneal radical prostatectomy (EERP) learning curve impact on outcomes.

Materials and methods

In a 5 year period (2004鈥?008) 270 patients underwent 5鈥? ports laparoscopic radical prostatectomy at a referral center in Brazil. The initial 70 cases learning curve protocol included low body mass index patients with low volume, low grade prostate cancer. After that there were no criteria to exclude laparoscopic surgery. The patients were analyzed in two groups: Group 1, first 70 patients (30 transperitoneal and 40 extra peritoneal)鈥攍earning curve and Group 2, last 200 patients - EERP only. Surgical and outcome parameters were compared through Student's t test and Fisher's Exact Test.

Results

The mean age was 65 years (卤8.2) and comparing Groups 1 and 2, mean operative time was 300 (卤190) versus 180 (卤100) minutes, blood loss 330 (卤210) versus 210 (卤180) mL, hospital stay 3 (2 to 5) versus 2 (1 to 3) days, positive surgical margins 15%versus 10%, erection sufficient to penetration in previous potent patients 73.3%versus 75%, respectively with no difference between groups. Overall, 78%of patients referred no previous impotence with groups鈥?equivalence. Severe urinary incontinence, transfusion and complications rates were higher in group 1 (p<0.05): 10%versus 2%, 12%versus 2.25%and 30%versus 12.5%, respectively. Peritoneum perforation occurred in 40%and conversion to open surgery was not required. Nerve sparing procedure was applied in 85%. In 3.5-years mean follow-up 90%of patients were free of PSA recurrence with no difference between groups.

Conclusion

Severe urinary incontinence, transfusion and complications rates are related to learning curve which is continuous, although a significant improvement is pragmatic after 70 cases. An intensive mentored training program should be considered to minimize the learning outlays.